On-Demand: A Diagnostic Pathway Post Cryptogenic Stroke-Presentation Slides

Presentation Slides

Pdf Summary

This document summarizes a presentation by Dr. Nagib Chalfoun on the diagnostic pathway for patients with cryptogenic stroke. Cryptogenic stroke refers to cases where the cause of the stroke remains unknown after evaluation.<br /><br />The presentation discusses the need for atrial fibrillation (AF) detection in cryptogenic stroke patients. AF is a major risk factor for stroke and leads to adverse outcomes such as increased risk of stroke, heart failure, dementia, and mortality. Detecting and treating AF earlier leads to better outcomes. The presentation emphasizes the importance of delivering high-quality, value-based care.<br /><br />The incidence of AF in stroke patients is estimated to be 20-25%, with 25% of stroke cases being the first manifestation of AF. Up to 30% of patients with cryptogenic stroke are found to have previously undetected AF. Various tools are available to detect AF, including Holter monitors, event monitors, patch monitors, and implantable loop monitors.<br /><br />Long-term monitoring with implantable cardiac monitors (ICMs) has been shown to increase AF detection and initiation of appropriate treatment, leading to a decreased risk of recurrent stroke. Short-term monitoring of 30 days may miss up to 88% of AF cases.<br /><br />The presentation discusses the journey of Spectrum Health in establishing an AF Clinic and an Implantable Cardiac Monitor Clinic for cryptogenic stroke patients. The importance of multidisciplinary collaboration, standardized approaches, and patient education is highlighted.<br /><br />The document also discusses the cost-effectiveness of ICMs for AF detection in cryptogenic stroke patients compared to other monitoring strategies. Immediate ICM placement after a cryptogenic stroke is cost-saving and leads to lower healthcare costs and out-of-pocket expenses for patients compared to wearable-to-ICM strategies.<br /><br />The presentation concludes by highlighting the key factors in starting a Cryptogenic Stroke Program, including engaging hospital leadership, neurology services, and developing clinical pathways. Patient education, standardized protocols, and the alignment of patients within the AF Clinic are crucial for successful management of the pathway. The cost-effectiveness of monitoring strategies should also be considered.

Keywords

cryptogenic stroke

diagnostic pathway

atrial fibrillation

AF detection

implantable cardiac monitors

recurrent stroke

AF Clinic

patient education

cost-effectiveness

clinical pathways